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General NPI Number Information
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NPI Number | 1326752684
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Entity Type | Individual
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Provider Name | NICHOLAS MUDRY
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Gender | Male
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 500 W PUTNAM AVE FL 2
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City | GREENWICH
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State | CT
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Zip | 06830-2937
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Country | US
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Telephone | 877-925-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 158 BROAD ST APT H
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City | MILFORD
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State | CT
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Zip | 06460-4758
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12235
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 143925
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License Number State | CT
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